Study: Opioids Don't Improve Quality of Life for Individuals With Chronic Noncancer Pain

Monday, March 05, 2018

Study: Opioids Don't Improve Quality of Life for Individuals With Chronic Noncancer Pain

Researchers have found that for individuals with chronic noncancer pain, opioids probably aren't delivering on what many presume to be their primary function—to improve overall quality of life by reducing pain and the emotional toll it takes.

In a study published in Health Services Research (abstract only available for free) researchers tracked data from individuals who participated in the Medical Expenditure Panel Survey (MEPS), a project that collects health information by way of 5 rounds of surveys, each spanning a 2-year period. The survey asked about respondents' level of pain, use of opioids, and health-related quality of life (HRQoL) based on responses to 2 questionnaires, 1 on mental health and 1 on physical health.

Authors of the study then focused on 5,876 respondents who reported chronic noncancer pain (CNCP), further dividing them into 3 groups: a no-use group, nonchronic opioid users (those who reported receiving at least 1 opioid prescription over a 12-month period but with a supply for fewer than 90 days), and chronic opioid users—those who reported receiving a prescription for opioids with a supply of 90 days or more in a 12-month period.

After controlling for demographic variables, comorbidities, and diagnoses, researchers found that physical and mental health scores did not vary significantly among chronic, nonchronic, and no-use groups—a result indicating that the use of opioids did not improve HRQoL any better than no opioids for individuals experiencing the same kinds of pain.

In fact, researchers point out, if there was any change to be noted, it would be that the chronic-use group reported slightly decreased physical health scores over time—but those changes did not result in a minimally clinically important difference from the other 2 groups.

"The ultimate goal of using opioids for the treatment of CNCP is to ease the burden of pain and hopefully improve HRQoLs," authors write. "Overall, these results suggest that opioid use for CNCP is not associated with better HRQoL [as measured through the tests included in MEPS]. Considering the risk of development of opioid dependence and addiction and unclear benefit on HRQoL, clinicians should carefully evaluate a treatment goal and whether participants with CNCP should continue receiving opioid therapy."

Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

Comments

As described, this study’s methods are fatally flawed to such a degree that the results are practically meaningless. I’ll just mention 3:
1) it’s non-randomized. Choosing people from a subgroup, especially ones in which the study participants have chosen to join, like MEPS, already introduces bias to any results.
2) It’s based on self-reporting, the most unreliable form of data gathering due to reasons such as different people interpret questions slightly differently and therefore answer differently, when there really is no objective difference e.g.) what one person reports as a 5/10 pain level, someone else answers as a 7/10 (the difference theoretically could be influenced by each participants previous experience with pain. If you’ve never had a truly 10/10 pain experience, you’re more likely to rate your pain higher than someone who has had that experience.
3) which neatly leads to the third : They apparently didn’t control for the most important measure - average pain level for each of the groups. Lower prescriptions = lower pain levels. Higher prescriptions = higher pain levels. That the group with the highest amount of pain, those “chronically” taking opioids, showed the same HRQoLs as the occasional pain groups isn’t a mark against opioids not working, but rather a testament to the fact that even with chronic pain, opioids can help improve your HRQoLs to a the level of low-pain people.
And by the way APTA, just because you provide a link to actual scientific, evidence-based research, doesn’t cover the fact that you’re misleading reader, either consciously or though ignorance.

Posted by Ian Cameron
on 5/19/2018 3:24 AM

While this might not be the most accurate study, there is a growing amount of evidence that we need to start looking for better alternatives.